| NPI | 1881917839 |
|---|---|
| Former Name | KELLI J WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 005179-1) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2010-03-04 |
| Last Update Date | 2014-03-10 |